EMJ Respiratory最新文献

{"title":"Established Statin Use Reduces Mortality From Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis","authors":"E. Fitzgerald, L. Duquette, Matthew Williams","doi":"10.33590/emjrespir/10311855","DOIUrl":"https://doi.org/10.33590/emjrespir/10311855","url":null,"abstract":"Background: Statin therapy (ST) has been associated with improved outcomes from sepsis. Our objective was to systematically review the association between established ST and outcomes of patients with community-acquired pneumonia (CAP) that is severe enough to require hospitalisation.\u0000Methods: Two meta-analyses were conducted following a search of articles published before 31st January 2013. After exclusions, seven studies were included to assess the effects of statins on 30-day mortality from CAP, and eight studies were included to assess the effects of statins on the development of CAP. Endpoints were a reduction in the risk of 30-day mortality or risk of developing CAP.\u0000Results: A reduction in the risk of 30-day mortality from CAP was identified in patients established on ST (pooled odds ratio [OR]: 0.70, 95% confidence interval [CI]: 0.65-0.76; adjusted OR: 0.58, 95% CI: 0.47-0.69). The pooled OR for risk of developing CAP in patients with and without established ST was 1.01 (95% CI: 0.98-1.04).\u0000Conclusion: There appears to be weak evidence to suggest a potential benefit of established ST. It is associated with a reduced risk of 30-day mortality in patients subsequently hospitalised with CAP. Further evidence is required, but ST could be considered as a means of reducing the risk of mortality from pneumonia.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"409 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127598883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in the Diagnosis of HIV-Associated Tuberculosis","authors":"A. Gupta-Wright, S. Lawn","doi":"10.33590/emjrespir/10313482","DOIUrl":"https://doi.org/10.33590/emjrespir/10313482","url":null,"abstract":"HIV-associated tuberculosis (HIV-TB) remains a global public health challenge, with the major burden being borne by countries in low-resource settings. If World Health Organization targets to reduce TB deaths by 95% and new cases by 90% are to be met by 2035, major improvements in diagnostic strategies are among the most pressing needs. HIV coinfection presents particular challenges in the diagnosis of TB due, for example, to the relatively low mycobacterial burden in sputum specimens and rapid dissemination beyond the lungs. Low and middle-income countries still typically rely on traditional diagnostics such as chest radiology and sputum microscopy, which lack sufficient accuracy. Desired characteristics for an HIV-TB diagnostic test are well described and include the ability to test a wide variety of clinical samples, diagnose extra-pulmonary TB, have good accuracy to detect low mycobacterial burden disease, and be deployable at the peripheries of healthcare systems. Following a long period of under-investment in TB research, development of TB diagnostics has progressed rapidly over the past decade and the technology landscape looks much more promising. This article will summarise advances in diagnostics that are particularly relevant to HIV-TB. The Xpert® MTB/RIF and Determine™ TB LAM assays have the most evidence assessing their use in HIV-TB. In addition to nucleic-acid amplification tests and antigen detection we will review new diagnostic technologies. Finally, we discuss whether use of empirical TB treatment offsets the potential impact and reduces the need for new diagnostics.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121181830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Neck Abscesses Complicating Acute Fusobacterial Tonsillitis","authors":"Elisabeth Hui, L. Lee, W. Manson","doi":"10.33590/emjrespir/10314980","DOIUrl":"https://doi.org/10.33590/emjrespir/10314980","url":null,"abstract":"A case of deep neck abscesses due to Fusobacterium necrophorum in a young adult patient after therapy with phenethicillin is reported. The clinical manifestations, diagnostic methods, therapy, and outcome are described.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122440303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Electronic Nose Arises Into the 21st Century","authors":"F. Fiorentino, J. L. Valera, J. Merino, B. Cosío","doi":"10.33590/emjrespir/10311712","DOIUrl":"https://doi.org/10.33590/emjrespir/10311712","url":null,"abstract":"Electronic noses (eNoses) are instruments designed to imitate the sense of smell. These devices are used to detect and precisely distinguish odours within complex samples at a relatively low cost, and these properties make them very useful in a diverse range of clinical scenarios. An eNose is typically\u0000composed of a multisensor array, an information-processing unit, and a pattern-recognition algorithm. The multisensor array combines to respond globally to a wide range of volatile organic compounds (VOCs) and the output provides a distinct digital response pattern. Clinical ‘breathprints’ or ‘smellprints’\u0000contain VOCs and respiratory diseases such as chronic obstructive pulmonary disease (COPD), asthma, and lung cancer can be detected by this novel technique. Moreover, patients with exacerbated COPD and a positive microbiological culture can be differentiated from those with stable disease. The eNose displays high accuracy in detecting obstructive sleep apnoea syndrome, and common conditions in the intensive care unit such as acute respiratory distress syndrome and ventilator-associated pneumonia have also been studied in relation to the use of eNoses. Information contained within breathprints interpreted by eNoses may serve as non-invasive biomarkers in respiratory medicine and infectious diseases, as well as other branches of medicine.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131409020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequent Exacerbators in Chronic Obstructive Pulmonary Disease: From Research to Clinical Practice","authors":"R. Hewitt, P. Mallia","doi":"10.33590/emjrespir/10314876","DOIUrl":"https://doi.org/10.33590/emjrespir/10314876","url":null,"abstract":"Acute exacerbations of chronic obstructive pulmonary disease (COPD) are major causes of morbidity and mortality and contribute to disease progression. The frequency with which COPD patients experience exacerbations can differ markedly between patients, even those with a similar severity of airflow obstruction. This has led to the concept of ‘frequent exacerbators’ that represent a unique phenotype of COPD patients who experience frequent exacerbations and have poorer outcomes compared with patients with infrequent exacerbations. However, the mechanisms whereby some COPD patients experience frequent exacerbations remain undetermined. Understanding the mechanisms of frequent exacerbations will lead to the development of new therapies that can be targeted to these high-risk patients, thereby reducing exacerbations and improving outcomes.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134288965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Isolated Intracranial Progression of Lung Cancer During Treatment with Systemic Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors (EGFR-TKIs)","authors":"A. Tufman, K. Schrödl, H. Scheithauer, T. Duell, E. Coppenrath, Rudolf Maria Hube","doi":"10.33590/emjrespir/10312113","DOIUrl":"https://doi.org/10.33590/emjrespir/10312113","url":null,"abstract":"Background: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are an effective treatment for non-small-cell lung cancer (NSCLC) harbouring EGFR mutations. The development of isolated central nervous system (CNS) metastases is a relevant clinical problem in patients who respond well to EGFR-TKIs.\u0000Methods: We present a patient with isolated progression of brain metastases during treatment of EGFRmutated NSCLC with an EGFR-TKI and review the treatment options in this setting, including the evidence for and toxicity of treatment with high-dose TKIs.\u0000Results: Oligometastatic CNS progression during TKI therapy may be treated locally. Both whole brain radiotherapy (WBRT) and stereotactic brain irradiation are well tolerated and effective in this setting. The use of high-dose pulsed TKIs is intended to increase the concentration of TKI in the brain and has been reported to be effective and without significant toxicity in case reports and small case series. These therapeutic options are illustrated in the case of a 44-year-old NSCLC patient who developed CNS progression after WBRT during second-line erlotinib and was treated locally with stereotactic radiosurgery (SRS) and, upon further CNS progression, with high-dose pulsed erlotinib. This resulted in intracerebral response; however, significant haemorrhage also occurred. Severe haemorrhage has not previously been described as a complication of high-dose pulsed erlotinib.\u0000Conclusion: Possible explanations for isolated CNS progression during TKI treatment include inadequate dosing across the blood—brain barrier and longer survival on TKIs. The efficacy and tolerability of high- dose pulsed TKIs for CNS metastases has been previously reported. None of the cases reported showed the severe haemorrhage and cerebral oedema that developed in our patient. Simultaneous anticoagulation as well as previous SRS may have predisposed our patient to haemorrhage and may prove to be relative contraindications to high-dose pulsed erlotinib. Most centres only see a few patients in this clinical situation, and co-operative efforts are needed to collect and analyse similar cases and to develop appropriate treatment strategies.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125554523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaler Devices: The past, the Present, and the Future","authors":"Sarah Utley","doi":"10.33590/emjrespir/10314624","DOIUrl":"https://doi.org/10.33590/emjrespir/10314624","url":null,"abstract":"Inhaler handling errors negatively impact asthma control and represent one of the most common challenges in asthma management. Overcoming inhaler handling errors can be achieved by increased awareness of errors, more explicit and consistent training in inhaler use, and development of ‘intuitive’ devices. Clinical studies have shown that dry powder inhalers (DPIs) have better dose consistency and delivery to the lungs, but this is also dependent on device and inhalation technique. In addition, recent clinical studies have demonstrated that Spiromax® is a more intuitive device than Turbuhaler®. In studies analysing patient device mastery, intuitive devices are preferred by patients because they are easy/simple to use and have effective dose delivery.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116491463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled Ambient Particulate Matter and Lung Health Burden","authors":"S. Upadhyay, K. Ganguly, T. Stoeger","doi":"10.33590/emjrespir/10314956","DOIUrl":"https://doi.org/10.33590/emjrespir/10314956","url":null,"abstract":"Increased ambient particulate matter (PM) has been associated with various cardio-respiratory disorders and emergency room visits due to short-term and long-term exposures. However, most of the efforts correlating PM exposure with human health hazards have primarily focused on cardiovascular impairments, although the lung acts as the primary port of entry, and is therefore also the primary target organ. Emerging evidences have shown an association between increased PM and respiratory illness, particularly chronic lung diseases. PM10, PM2.5, ultrafine particles, or nanoparticles (NPs) are of interest in this regard. Particle surface area increases with decreasing size and surface related parameters such as oxidative potency, solubility, and bioavailability, and are widely regarded as the parameters determining particle toxicity. Factory utility smoke stacks, vehicle exhaust, wood, and biomass burning act as the primary sources for ambient PM, coupled with composition variability. Revolution of nanotechnology during the last decade brought forward concerns about NPs as a potential new health hazard as well. Epidemiological, clinical, and experimental studies suggest oxidative stress, inflammation, impaired inflammation resolution, and altered coagulation cascade homeostasis as the causative mechanisms of both pulmonary and cardiovascular impairments due to PM exposure. Children, the elderly, and individuals with pre-existing conditions are found to be the most vulnerable subjects. Respiratory symptoms of increased PM exposure include increased infection, pneumonia, chronic bronchitis, emphysema, exacerbation of asthma and chronic obstructive pulmonary disease, declined forced expiratory volume in 1 second, and forced vital capacity, apart from the classically known phenomenon of asbestosis, silicosis, mesothelioma, lung cancer, and pneumoconiosis.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124562486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Insights Into Chronic Obstructive Pulmonary Disease (COPD): An Overview","authors":"S. Singh Sohal, M. Eapen, Shakti Dhar Shukla, J. Courtney, M. Q. Mahmood, E. Haydn Walters","doi":"10.33590/emjrespir/10312398","DOIUrl":"https://doi.org/10.33590/emjrespir/10312398","url":null,"abstract":"Chronic obstructive pulmonary disease (COPD) is mainly caused by smoking and presents with shortness of breath that is progressive and irreversible. It is a worldwide health problem and the fourth most common cause of chronic disability and mortality, even in developed countries. It is a complex disease in which both the airway and lung parenchyma are involved. In this review we will be mainly focusing on the airway component of the disease. We have reviewed the current literature on airway inflammation and remodelling in smoking-related COPD. It is not only the tobacco smoking which can lead to chronic inflammation, but also the persistent presence of pathogenic microorganisms in the airways. Detailed data on these in COPD are sparse. One potential mechanism contributing to small airway fibrosis/obliteration and change in extracellular matrix is epithelial mesenchymal transition (EMT). When associated with angiogenesis (so called EMT-Type-3) it may well also be the link with the development of cancer, which is closely associated with COPD, predominantly in large airways. In this paper we focused on: 1) the role of inflammation in developing COPD; 2) recent observations on structural and cellular changes which might have relevance to a major feature of COPD that is poorly understood, namely, the striking vulnerability of patients with COPD to develop lung cancer; 3) the potential role of respiratory infections in COPD.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127767955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COPD Patients’ Needs and Current Treatment Options","authors":"J. Viney","doi":"10.33590/emjrespir/10314007","DOIUrl":"https://doi.org/10.33590/emjrespir/10314007","url":null,"abstract":"The objective of this meeting was to review the complexities surrounding the management and treatment options for different populations of chronic obstructive pulmonary disease (COPD) patients. Bartolome Celli chaired the symposium and outlined some of the current challenges for COPD management. Donald Tashkin discussed clinical assessment of the newly-diagnosed COPD patient, before moving on to review the initial pharmacotherapy options that are available, specifically the long-acting beta or muscarinic agonists. Claus Vogelmeier presented the options for COPD patients who remain symptomatic despite initial treatment, using data from clinical trials such as SPARK to compare different treatment approaches, and Jadwiga Wedzicha focused on higher-risk patients, presenting pertinent data from studies on patients with increased rates of COPD exacerbation. Finally, Bartolome Celli summarised the meeting and provided his expert insight on classifying COPD patients into phenotypic groups.","PeriodicalId":300382,"journal":{"name":"EMJ Respiratory","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133595058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}